ArticleJournal of hepatology2025
Assessment of liver graft quality during hypothermic oxygenated perfusion: The first international validation study.
Article in Journal of hepatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Normothermic Perfusion Versus Static Cold Storage in Liver Transplantation: A Meta-Analysis of Randomized Trials.Clinical transplantation · 2025Pooled it
- Portal-Venous Hypothermic Oxygenated Perfusion for Liver Transplant: A Randomized Clinical Trial.JAMA surgery · 2026Trial
- Long-term Follow-up After Hypothermic Oxygenated Machine Perfusion in DCD Liver Transplantation: Results of a Randomized Controlled Multicenter Trial (DHOPE-DCD).Annals of surgery · 2025Trial
- A diagnostic accuracy study of mitochondrial FMN during hypothermic oxygenated perfusion to guide liver utilization and avoid normothermic assessment.Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · 2026Article
- The Association of Flavin Mononucleotide and Lactate During Normothermic Regional Perfusion with Post-Transplant Liver Outcomes: An Exploratory Study.Medicina (Kaunas, Lithuania) · 2026Article
- What we can learn from hibernators and other adapted animals about organ transplantation: mechanisms of cold resistance and enhanced regeneration.Protein & cell · 2026Article
- Re-Evaluating Donor-Recipient Risk Scores in the Machine Perfusion Era Using a Large Multicenter Cohort: Do Traditional Predictive Models Still Apply?Clinical transplantation · 2026Article
- MSC-Derived Extracellular Vesicles Mitigate Ischemia-Induced Energetic Dysfunction During Ex Situ Perfusion of Rat Livers.Antioxidants (Basel, Switzerland) · 2026Article
- From Rescue to Risk: Challenges and Controversies in Pushing the Boundaries of Organ Utilization by Machine Perfusion.Artificial organs · 2026Review
- Reduced Histidine Metabolism Is Associated with Early Allograft Dysfunction Following Liver Transplantation.Metabolites · 2026Article
- Protective effect of Caftaric Acid against hepatic cold ischemia/reperfusion injury in the liver.Biology direct · 2026Article
- Fluorescence spectroscopy precorrection model robust to large variability of optical properties: application to point of care quantitative liver graft viability assessment.Biomedical optics express · 2026Article
- Mitochondrial hyperoxidation contributes to warm ischemia-reperfusion injury in rat and pig livers.Communications medicine · 2026Article
- Advancing the enhanced recovery after surgery paradigm in liver transplantation: evidence-based strategies for a comprehensive care continuum.Hepatobiliary surgery and nutrition · 2026Article
- Time as a Therapeutic Ally: The Promise of Long-Term Solid Organ and Tissue Perfusion.Transplant international : official journal of the European Society for Organ Transplantation · 2026Review
- Graft quality assessment during machine perfusion in liver transplantation: a review of current evidence and emerging strategies.Frontiers in transplantation · 2026Review
- Artificial intelligence in liver transplantation: current state, future prospects, and challenges - a narrative review.Przeglad gastroenterologiczny · 2026Review
- [Research progresses in ex vivo liver perfusion technology].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Review
- Liver Machine Perfusion: Past, Present and Future Directions.Biomedicines · 2025Review
- Tissue inhibitor of metalloproteinase-2 predicts early allograft dysfunction after liver transplantation.European journal of medical research · 2025Article
Corrections and comments
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Authors and funding
36 authors.
Funding
Abstract
BACKGROUND &
aimsWhile it is currently assumed that liver assessment is only possible during normothermic machine perfusion, there is uncertainty regarding a reliable and quick prediction of graft injury during ex situ hypothermic oxygenated perfusion (HOPE). We therefore intended to test, in an international liver transplant cohort, recently described mitochondrial injury biomarkers measured during HOPE before liver transplantation.
methodsPerfusate samples of human livers from ten centers in seven countries with HOPE experience were analyzed for released mitochondrial compounds, i.e. flavin mononucleotide (FMN), NADH, purine derivatives and inflammatory markers. Livers deemed unsuitable for transplantation served as negative controls.
resultsWe collected 473 perfusate samples of human donation after cardiac death (n = 315) and donation after brain death (n = 158) livers. Fluorometric assessment of FMN in perfusate was validated by mass spectrometry (R = 0.7011, p <0.0001). Graft loss due to primary non-function or cholangiopathy was predicted by perfusate FMN values (c-statistic mass spectrometry 0.8418, 95% CI 0.7466-0.9370, p <0.0001; c-statistic fluorometry 0.7733, 95% CI 0.7006-0.8461, p <0.0001). Perfusate FMN values were also significantly correlated with symptomatic non-anastomotic strictures and kidney failure, and superior for the prediction of graft loss than conventional scores derived from donor and recipient parameters, such as the donor risk index and the balance of risk score. Mitochondrial FMN values in liver tissues of non-utilized livers were low, and inversely correlated to high perfusate FMN values and purine metabolite release.
conclusionsThis first international study validates the predictive value of the mitochondrial cofactor FMN, released from complex I during HOPE, and may therefore contribute to a better risk stratification of injured livers before implantation. IMPACT AND IMPLICATIONS: Analysis of 473 perfusates, collected from ten international centers during HOPE (hypothermic oxygenated perfusion), revealed that mitochondria-derived flavin mononucleotide values in perfusate are predictive of graft loss, cholangiopathy, and kidney failure after liver transplantation. This result is of high clinical relevance, as recognition of graft quality is urgently needed to improve the safe utilization of marginal livers. Ex situ machine perfusion approaches, such as HOPE, are therefore likely to increase the number of useable liver grafts.
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